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At least 523 records · Page 29Linked to original sources
PubMed1999

Response of cutaneous leishmaniasis (chiclero's ulcer) to treatment with meglumine antimoniate in Southeast Mexico.

Cutaneous leishmaniasis, known as chiclero's ulcer in southeastern Mexico, is characterized by a predominantly single, painless, ulcerated lesion, without lymphangitis or adenopathy. When located on the ear, it tends to become chronic, causing destruction of the pinna and disfigurement. It is caused predominantly by Leishmania (L.) mexicana. Although pentavalent antimonials (Sb5+) are the mainstay of leishmanial therapy and have been used for more than 50 years, dosage regimens have been repeatedly modified and the best one has not been fully identified. The main purpose of the present study was to investigate the response of chiclero's ulcer to treatment with meglumine antimoniate. One hundred five patients were treated with meglumine antimoniate at a daily dose of 1 ampule per day (425 mg of Sb5+) until healing. The lesions healed after a mean of 25 days (range = 5-60 days).

Adolescent↗
PubMed2004

Polymyositis associated with urinary bladder cancer: an autopsy case.

A 56-year-old man suffered from muscle weakness with elevated serum creatine kinase. Under diagnosis of polymyositis, the patient was treated with corticosteroid, methotrexate and cyclosporin A. Eleven months after the first signs of muscle weakness, the patient suffered an abrupt onset of anuria and underwent hemodialysis. The patient died of respiratory insufficiency 14 months after the first signs of muscle weakness. Autopsy findings revealed associated urinary bladder cancer with histological indications of adenosquamous cell carcinoma, liver metastasis and cancerous lymphangitis of the lung.

Carcinoma, Adenosquamous↗
PubMed1991

Reactions to argasid tick bites by island residents on the Great Barrier Reef.

OBJECTIVE: To attribute a cause and quantify allergic-like symptoms observed among island residents. DESIGN: Skin prick tests and intradermal injections with ultraviolet-irradiated, filtered (0.22 microns) whole-body homogenates of the soft tick, Ornithodoros capensis, were used to reproduce experimentally the symptoms observed. SETTING: Heron Island, Great Barrier Reef, Australia. PARTICIPANTS: Island residents were designated as such after having spent more than 1 month on the island during the summer seabird breeding season. INTERVENTIONS: Control measures were instigated using a residual insecticide, delta-methrin, sprayed inside sleeping quarters. MAIN OUTCOME MEASURES: Acaricide spraying reduced (X2 = 4.42; P less than 0.05) the number of island residents complaining of having been bitten by ticks, yet was considered an inefficient control measure as 67% reported being attacked by ticks after spraying. RESULTS: Among 97 island residents, elevated total IgE levels were associated with reaction to tick bite in 11 cases (X2 = 27.17; P less than 0.001), but were not of reliable diagnostic value. Symptoms included intense pruritus, blistering (a major feature), erythema, weeping lesions, lymphangitis, dull ache, rheumatic pain and general lassitude, and intense discomfort. Sera from two of four volunteers with known reactions to O. capensis and one of four others with reactions to the Australian paralysis tick, Ixodes holocyclus, cross-reacted with antigens from a total of four of six biting/stinging and non-biting arthropods (radioallergosorbent tests). CONCLUSIONS: Symptoms associated with reactions to tick bite peaked in severity at 35-40 hours and thus the response was most likely delayed type IV hypersensitivity.

Animals↗
PubMed2005

Lymphatic filariasis: disease outbreaks in military deployments from World War II.

Lymphatic filariasis (LF) is the second most common parasitic disease worldwide, after malaria. It should always be considered in the differential diagnosis for military personnel returning from disease-endemic areas. Numerous outbreaks of LF have been reported in military deployments from World War II. In contrast to the presentation of LF in indigenous populations, which often involves such uncommon complications as elephantiasis and hydrocele, the clinical presentation of LF in military personnel can vary widely and is often vague and nondescript. Common symptoms are pain and swelling of the genitalia, closely followed by lymphangitis of the arms and legs. All three species produce similar disease.

Animals↗
PubMed1982

Recurrent cellulitis after saphenous venectomy for coronary bypass surgery.

We describe a previously unreported complication of coronary artery bypass grafting, recurrent cellulitis. Five patients had 20 episodes of acute cellulitis, each occurring in the lower extremity in which saphenous venectomy had been done. The cases were striking because the patients presented with high fever and considerable systemic toxicity. The appearance of the lesions, presence in one case of obvious associated lymphangitis, and prompt response in three instances to therapy with penicillin alone all suggest group A streptococcal infection. In one case, a beta-hemolytic, bacitracin-susceptible Streptococcus strain was isolated from the lesion. The pathogenesis of this syndrome remains obscure but, based on our understanding of postsurgical erysipelas, this cellulitis likely results from the interplay of several factors, including local compromise of lymphatic drainage, direct bacterial invasion, and acquired hypersensitivity to streptococcal exotoxins.

Adult↗
PubMed1992

Paratuberculosis in saiga antelope (Saiga tatarica) and experimental transmission to domestic sheep.

Mycobacterium paratuberculosis was isolated in low numbers from the small intestine and associated mesenteric lymph nodes of a saiga antelope (Saiga tatarica) using routine culture techniques in spite of histologic evidence of high numbers of acid-fast bacteria in these tissues. Two newborn domestic sheep were fed the ground intestinal tissue containing acid-fast bacteria and the progression of the experimental disease was followed by fecal culture, immunodiffusion (AGID) and lymphocyte stimulation (LST) tests. One experimentally infected sheep developed progressive clinical illness 1 yr postinoculation. Few M. paratuberculosis were isolated from feces or tissues although an extensive granulomatous mycobacterial enteritis, lymphadenitis and lymphangitis were observed containing large numbers of typical acid-fast organisms. No clinical illness was observed in the second inoculated sheep after 18 mo of observation, although infection was demonstrated at necropsy. Both sheep developed AGID and LST reactions indicative of paratuberculosis. This study demonstrated that a difficult to culture isolate of M. paratuberculosis was responsible for paratuberculosis in captive wild ruminants and was transmissible to domestic sheep. Diagnosis of paratuberculosis in four of eight of the imported saiga antelope and in eleven of their 18 offspring indicates the importance of this disease in management of captive wild ruminants and the ease with which this organism can be transmitted.

Animals↗
PubMed1998

[Melkersson-Rosenthal syndrome].

Melkersson-Rosenthal syndrome is a rare entity and is, in its complete presentation, characterized by the association of recurrent orofacial swelling, peripheral facial palsy and plicated tongue. Clinical diagnosis of incomplete forms, frequently described, is based on major and minor features, currently accepted by numerous clinicians. For most investigators, Miescher's granulomatous macrocheilitis is a monosymptomatic form of the affection. Histopathological findings reveal non-caseating epithelioid cell granulomas, with sometimes perivascular pathognomnic arrangement, which typically shows an obliterant epithelioid lymphangitis. The etiology of the disorder is unknown; a possible association with Crohn's disease has been proposed. Local or general corticosteroids therapy is usually proposed possibly with a cheiloplastic procedure.

Diagnosis, Differential↗
PubMed1999

[Contribution of high-resolution volume computed tomography (HRVCT) for the exploration of diffuse pulmonary infiltrative disorders].

AIM: To assess high-resolution volume computed tomography (HRVCT) for the investigation of diffuse pulmonary infiltrative disorders. PATIENTS AND METHODS: Thirty patients with diffuse interstitial disease (idiopathic fibrosis n = 7, silicosis n = 4, asbestosis n = 5, sarcoidosis n = 7, histiocytosis n = 2, lymphangitis carcinomatosa n = 2, tuberculosis n = 1, bronchiolitis obliterans n = 1) were explored using high-resolution computed tomography (HRCT) and HRVCT. All diagnoses were proven by fiberscopy, bronchoalveolar lavage and respiratory function tests and/or lung biopsy. The HRVCT protocol consisted of spiral tomography using 10 mm slices. Data were processed with a Windows Advantage workstation (GE Milwaukee). Two readers compared multiprojection volume reconstruction (MPVR) using maximal intensity projection (MIP) and minimal intensity projection (MINIP) displays with millimetric HRCT slices acquired at the same volume. RESULTS: Micronodules were detected better with HRVCT than with HRCT. MIP mode enabled better distinction between nodules and vessels. MINIP mode enabled better detection of cysts in the pulmonary parenchyma than HRCT. The honeycomb aspect of pulmonary fibrosis was differentiated better than super-infected central-lobar emphysema. MINIP mode enabled detection of ground glass opacities which were not visible on HRCT. Certain anomalies were however detected only on HRCT. HRVCT was very sensitive to movement effects which altered image quality, particularly in the MINIP mode. CONCLUSION: HRVCT is a new and promising approach for investigating diffuse pulmonary infiltrative disorders.

Adult↗
PubMed1999

Principles of surgical treatment of chronic lymphoedema.

Lymphoedema, refractory to non-operative management, may require surgical treatment. Potential indications include impaired limb function, recurrent episodes of cellulitis and lymphangitis, intractable pain, lymphangiosarcoma and cosmesis (patient unwilling to undergo more conservative treatment and willing to proceed even with experimental operations). The principle of excisional operations is to remove excess tissue to decrease volume of the extremity. Good reduction can be achieved with staged resection of the subcutaneous tissue, with resection of the excess skin and using the remainder for coverage. However, prolonged hospitalization, poor wound healing, long surgical scars, sensory nerve loss, residual oedema of the foot and ankle and poor cosmetic results can be significant problems and prevent offering such procedures short of a large and truly disabling lymphoedema, not responding to medical measures. Physiologic operations have been aimed at restoring lymphatic transport capacity, most frequently with lymphovenous anastomoses or lymphatic grafting. Chylous reflux due to valvular incompetence has been treated effectively by ligation and excision of retroperitoneal lymphatics, with or without lymphovenous anastomoses. Lymphovenous anastomoses operations for obstructive lymphoedema have been performed for several decades, but their use continues to be controversial. Such reconstructions can be indicated in a subset of patients who have proximal obstruction with preserved or dilated lymphatics distally. While few groups have reported good late clinical results, direct confirmation of long-term patency of lymphovenous anastomoses in patients is unavailable. Lymphatic grafting is a promising operation, but it requires true microsurgical expertise and commitment to treat this frequently frustrating and difficult disease. Long-term patency rates associated with documented clinical improvement have to be reported in larger number of patients, operated on in more than one centre before this operation can be recommended for treatment as an alternative to conservative measures. The large number of individual surgical techniques of physiological and excisional operations that are practiced today worldwide to treat lymphoedema continues to be testimony to our frustration in dealing with this difficult problem.

Chronic Disease↗
PubMed1999

[Multi-drug resistant breast cancer responding to chemotherapy with docetaxel (taxotere: TXT)].

The patient was a fifty-five year old female who had stage IVb advanced breast cancer with hypoxia due to bilateral pulmonary metastases and lymphangitis. The cancer was adriamycin (ADM) and multi-drug resistant. We administered docetaxel (taxotere: TXT) 60 mg/m2 every 3 weeks. After 2 courses, the pulmonary metastases had become remarkably reduced in size and hypoxia was reduced and performance status (PS) improved. Major toxic defects were grade-4 neutropenia and hair loss. The patient could be discharged from the hospital without O2 inhalation and enjoyed a better quality of life (QOL). This chemotherapy is thought to be effective against ADM and multi-drug resistant breast cancer.

Antineoplastic Agents, Phytogenic↗
PubMed1999

[Palliative chemo-radiotherapy for abdominal recurrence of esophageal carcinoma--case report].

A 71-year-old man with stage IV esophageal carcinoma was treated by chemo-radiotherapy (5-FU 500 mg/day + CDDP 10 mg/day for 4 weeks and 67.6 Gy of RT). The esophageal tumor showed a complete response to the treatment. Six months later, he had obstructive jaundice due to an abdominal recurrent mass. A secondary (palliative) CRT was performed (5-FU 500 mg/day + CDDP 10 mg/day for 3 weeks and 45 Gy of RT). The abdominal tumor became remarkably smaller and jaundice disappeared. Though the patient died from pulmonary carcinomatous lymphangitis, the primary lesion showed CR. CRT was very effective for local treatment and for palliative therapy.

Aged↗
PubMed1999

[Truth after death].

Diagnosis is central to medicine. In spite of tremendous diagnostic technological advances, no infallible test exists and in the complex diagnostic process the physician may well get lost. The ultimate feedback on the accuracy of diagnosis is the autopsy. Five patients illustrate that the autopsy may disclose unexpected results. The first patient was a 9-year-old girl who suffered from daily abdominal spasmodic pain but each time recovered. She died suddenly; autopsy revealed intestinal intussusception. A 46-year-old man who was treated for hypertension developed pain in the chest and the lower back, but there were no other signs of myocardial infarction. He died suddenly; autopsy revealed a dissecting aortic aneurysm with rupture in the left pleural cavity. A 21-year-old woman, an excellent swimmer, drowned during a swim in the sea. Autopsy revealed severe widespread coronary disease with multiple myocardial infarction. A 32-year-old Surinam woman developed acute coma and died from cardiorespiratory arrest. At autopsy she had massive pulmonary embolism and generalized lymphadenopathy due to sarcoidosis. The last patient, a 32-year-old woman suffered from fatigue after her fourth child was born. She was admitted with severe dyspnoea and her chest X-ray showed interstitial fibrosis. She died presently and autopsy revealed metastatic colon carcinoma with pulmonary lymphangitis carcinomatosa. Systematic reviews of the results of autopsies show no decline in the percentage of false diagnoses and/or unexpected findings in spite of the enormous growth of the diagnostic armamentarium. Although we may radiologically 'slice' the body in incredible detail or investigate human cells at the molecular level, the autopsy has by no means become obsolete and is an invaluable tool for quality control and teaching.

Adenocarcinoma↗
PubMedDate not supplied

[Sphenoid metastasis mimicking a meningioma as the initial feature of adenocarcinoma of the prostate].

INTRODUCTION: Presentation of adenocarcinoma of the prostate as an intracranial metastasis is uncommon. This metastasis tends to be seen in the sphenoid bone, and in this case it is difficult to differentiate radiologically from a meningioma. Because this cancer is treatable, the differential diagnosis must be resolved as soon as possible. CLINICAL CASE: A 72 year old man presented with a rapidly progressive left parasellar syndrome. On neuroimaging there was a tumour at the level of the left lesser wing of the sphenoid, which was isodense and iso-intense and also showed homogeneous uptake of contrast material. On angiography the circulation was pathological with homogeneous delayed filling. The initial diagnosis was meningioma of the lesser wing of the sphenoid. Months later the patient complained of bone and respiratory problems. At this time plain chest X-ray was compatible with carcinomatous lymphangitis. Therefore, tumour markers were studied and for the first time the specific prostatic antigen was investigated and found to be raised. Although there were no symptoms of prostatism, per rectum there was a malignant prostatic mass. In spite of complete hormone block, his illness followed an unfavorable course. At necropsy there was adenocarcinoma of the papillary prostate and a metastasis in the left lesser wing of the sphenoid. CONCLUSIONS: In elderly men, detection of a sphenoid tumour, which radiologically may appear to be a meningioma and although prostatism has not been diagnosed, the possibility of prostatic metastasis should be considered. Per rectum examination and specific prostatic antigen determination should be done in these patients.

Adenocarcinoma↗
PubMed1999

[Pleuropulmonary metastases of female cancers].

Pleuropulmonary metastasis occurs in 30 to 50% of all patients with cancer. Certain metastases occur specifically in females: breast and ovary cancer. There are six different clinical presentations of bronchopulmonary metastases: unique or multiple nodular images, mediastinal nodes, carcinomatous lymphangitis, bronchial metastasis, tumoral emboli, and metastatic bronchiolo-alveolar metastatic cancer. When the primary cancer is not known, a minimum number of investigations are needed: thyroid and pelvic ultrasound, mammography, colonscopy for certain cases, alfa-fetoprotein assay, neuron-specific enolase and beta HCG. Metastatic pleurisy accounts for 45% of all cases of pleurisy. In women, neoplastic pleural effusions result from breast cancer (37%), genitourinary tract cancer (20%), and lung cancer (15%).

Breast Neoplasms↗
PubMedDate not supplied

Estimated costs of acute adenolymphangitis to patients with chronic manifestations of bancroftian filariasis in India.

In India, lymphatic filariasis persists as a major cause of clinical morbidity and as an impediment to socio-economic development. The direct costs incurred for the treatment of adeno-lymphangitis (ADL) episodes and the consequent indirect costs due to loss of income were determined from selected agricultural labour-intensive rural endemic pockets in Tamil Nadu. Information on the occurrence of ADL, its frequency and duration were collected using semi-structured questionnaire from randomly selected patients afflicted with chronic manifestations of bancroftian filariasis. Direct (treatment) cost per year per patient was found to range from Rs. 30 to 101 among patients with different manifestations. Income foregone (indirect cost) annually by each patient, which is a function of frequency and duration of ADL ranged from Rs. 182 to 702. ADL episodes among filarial patients alone cost a minimum of Rs. 4515 million for the nation every year. Cost benefit analysis of filariasis control programme in India showed that the benefits in terms of savings on treatment and work lost due ADL alone exceeded the cost by 24%. The per capita cost of the National Filaria Control Programme was calculated to be Rs. 2.6 per annuam.

Acute Disease↗
PubMed2001

[Two-step tuberculin skin test in general hospital workers--comparison with nursing home workers].

In 1998, the Japanese Society for Tuberculosis recommended two-step tuberculin skin test (TST) for medical workers. As a large majority of the Japanese were BCG vaccinated in their childhood, it is difficult to distinguish true infection from booster effect. In Japan, it is important to record individual baseline tuberculin reactivity by two-step TST. Two-step TST was performed on 126 general hospital workers and 47 nursing home workers, excluding those whose initial TST was strongly positive, according to the recommendation of the Japanese Society for Tuberculosis in 1998 (strongly positive TST in Japan is defined as the reaction with other intensive responses such as double skin erythema, bleb, lymphangitis, etc.). Diameter of erythema of TST among hospital workers v.s. nursing home workers were as follows. In the initial TST: 23.2 +/- 16.7 mm v.s. 14.2 +/- 10.3 mm (p < 0.001), in the second TST: 26.3 +/- 17.1 mm v.s. 16.7 +/- 9.9 mm (p < 0.02), baseline of TST: 32.0 +/- 18.3 mm v.s. 19.4 +/- 10.7 mm (p < 0.001). Booster effect of TST in hospital workers was +9.8 +/- 15.1 mm, while it was +4.8 +/- 7.8 mm (not significant) in nursing home workers. Among those 30 years and over, these differences were no found, except diameter of erythema in the initial TST. In our hospital with no beds for TB, in the past 10 years, tuberculosis has not been broken out among our hospital workers, while several patients with pulmonary tuberculosis have been diagnosed every year (6 patients in 1999). Thus, some hospital workers might be exposed to infection with tuberculosis from these patients. On the other hands, no tuberculosis patients had been diagnosed in the nursing home, and young nursing home workers very rarely exposed to infection with tuberculosis in their life, and they are similar to the general population. This study suggested that hospital workers were more frequently exposed to tuberculosis infection than other workers.

Adult↗
PubMed2001

[Necrotizing fasciitis. Clinical criteria and risk factors].

Necrotizing cellulitis and fasciitis may be difficult to recognize. When skin necrosis is not obvious, the diagnosis must be suspected if there are signs of severe sepsis (accelerated heart or respiratory rates, oliguria, mental confusion.) and/or some of the following local symptoms or signs: severe spontaneous pain, indurated edema, bullae, cyanosis, skin pallor, absence of lymphangitis, skin hypoesthesia, crepitation, muscle weakness, foul smell of exudates. Many risk factors are suspected. A recent case-control study demonstrated that using ibuprofen increased the risk of cellulitis complicating chickenpox in children. Evidence is lower for other risk factors that are present with a high prevalence in most series: local lesion of skin or mucous membranes (acute or chronic disease, traumatism, surgery.), diabetes, arteriopathy, alcoholism, obesity, immunosuppression, NSAIDs. The risk of streptococcal necrotizing fasciitis is increased when in contact with patients infected by the same streptococcus.

Fasciitis, Necrotizing↗
PubMed2001

[Two-step tuberculin testing and BCG vaccination in the personnel of a medical and pharmaceutical university].

In an attempt to cope with recent nosocomial spread of tuberculosis, the tuberculin test with a 0.05 microgram of 0.1 ml intradermal dose of purified protein derivative was performed by a two-step procedure on the personnel of a medical and pharmaceutical university, followed by BCG vaccination for non-reactors in the second test. The second test was repeated after two weeks in all but those with erythema of 10 mm or more in diameter associated with double erythema, vesicle formation, and/or necrosis on the initial testing. The first test was done in a total of 935 participants (73% of all personnel) with a median age of 37 (range, 21-67) years. The rate of participation, by occupation, in the hospital personnel ranged from 63% (183/289) for doctors to 98% (351/358) for nurses. The size of erythema showed a unimodal distribution with a peak in the range of 10-19 mm, with a median of 20 mm (range, 0-102). Reactions below 9 mm, which are interpreted as negative, were found in 16% of all participants, and those above 30 mm in 35%. Among participants aged 20-49 years, especially among nurses, reactions tended to be larger with increasing age. Among 539 participants undergoing repeated testing, reactions between the first and second tests correlated well, showing a median increase in size of 10 mm (range, -43-(+)70) on retesting. Reactions above 30 mm associated with an increase in size larger than 20 mm, among those initially below 29 mm in diameter, were observed in 28% of those retested. Adverse reactions such as vesicle formation with or without hemorrhage, or lymphangitis occurred in 2.5% of all participants on the initial testing and in 1.5% on the retesting, with the highest frequency seen in those aged 30-39 years. BCG was administered to 26 of the 49 participants with a negative reaction on the second test. All vaccinees with a median age of 30 (range, 21-46) years showed tuberculin conversion after two months without developing Koch's phenomenon soon after the vaccination. Incidentally, it is desirable that two-step tuberculin testing such as that in the present study should also be performed using the diameter of induration, particularly that measured transversely, since erythema is not used in any other country than Japan.

Adult↗